Prevalence and correlates of stunting among the school-age population in North-Central Nigeria

Introduction: stunting remains a huge public health concern among developing Nations. However, the burden of this problem among the school-age population appears to have been eclipsed by most nutritional surveys that focus more on the under-fives. This study aimed to demonstrate the prevalence, and identify socio-demographic factors that are associated with stunting among the school-age children in North central Nigeria. Methods: this was a descriptive cross-sectional study that involved 450 pupils, aged 6-12 years from 10 randomly selected primary schools in Jos, Plateau state. Anthropometric indices were measured using standard techniques and the Height-for-age z-scores were generated using the WHO Anthroplus software. Socio-demographic details were obtained using semi-structured questionnaires. Data were analysed using EPI infoTM statistical software 7.1.5.2. Results: the mean age of the subjects was 9.3 ± 1.8 years and the male to female ratio was 1:1.1. The prevalence of stunting was 10.5%. The prevalence of stunting was significantly higher among pupils that attended public schools (p<0.0001), those whose mothers had less than secondary level of education (p=0.0427), those between the ages of 10-12 years (p<0.0001), those from the lower socio-economic class (p=0.0021), and those whose family sizes were larger than six family members (p=0.0063). Conclusion: the substantial burden of stunting among the school age population has significant correlation with certain socio-demographic factors. Addressing these factors by alleviating poverty, promoting maternal literacy and encouraging family planning may, perhaps, lessen the burden of stunting among the school-age group in Northern Nigeria

Hypothermia in preterm infants admitted to low-resource neonatal units in northern Nigeria: an observational study of occurrence and risk factors

Background: Hypothermia is an important cause of morbidity and mortality among preterm and low-birth-weight neonates. In resource-constrained settings, limited referral infrastructure and technologies for temperature control potentiate preterm hypothermia. While there is some documentation on point-of-admission hypothermia from single center studies, there are limited multicenter studies on the occurrence of hypothermia among preterm infants in resource-limited-settings. Therefore, we conducted a multicenter study to determine the prevalence and risk factors for hypothermia at the time of admission and during the first 72 h after admission in northern Nigeria. Method: We carried out a prospective cohort study on preterm infants admitted to four referral hospitals in northern Nigerian between August 2020 and July 2021. We documented temperature measurements at admission and the lowest and highest temperatures in the first 72 h after admission. We also collected individual baby-level data on sociodemographic and perinatal history data. We used the World Health Organization classification of hypothermia to classify the babies’ temperatures into mild, moderate, and severe hypothermia. Poisson regression analysis was used to identify risk factors for moderate-severe hypothermia. Results: Of the 933 preterm infants enrolled, 682 (72.9%) had hypothermia at admission although the prevalence of hypothermia varied across the four hospitals. During the first 24 h after admission, 7 out of every 10 babies developed hypothermia. By 72 h after admission, between 10 and 40% of preterm infants across the 4 hospitals had at least one episode of moderate hypothermia. Gestational age (OR = 0.86; CI = 0.82–0.91), birth weight (OR = 8.11; CI = 2.87–22.91), presence of a skilled birth attendant at delivery (OR = 0.53; CI = 0.29–0.95), place of delivery (OR = 1.94 CI = 1.13–3.33) and resuscitation at birth (OR = 1.79; CI = 1.27–2.53) were significant risk factors associated with hypothermia. Conclusion: The prevalence of admission hypothermia in preterm infants is high and hypothermia is associated with low-birth-weight, place of delivery and presence of skilled birth attendant. The prevalence of hypothermia while in care is also high and this has important implications for patient safety and quality of patient care. Referral services for preterm infants need to be developed while hospitals need to be better equipped to maintain the temperatures of admitted small and sick newborns

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Rural farmers’ readiness to access information from the National Farmers Helpline Centre, National Agriculture Extension and Research Liaison Services ABU Zaria, Kaduna State, Nigeria

The study investigated rural farmers’ readiness to access agricultural information from the National Farmers Helpline Centre NAERLS, ABU Zaria. The specific objectives were to describe the socio-economic characteristics of Nigerian rural farmers, identify the major agricultural information accessed by rural farmers from the National Farmers Helpline Centre and identify the various constraints faced by Nigerian rural farmers in accessing agricultural information from the National Farmers Helpline Centre. A random sampling technique was employed to select one thousand six hundred (1600) rural farmers across the six agro ecological zones from the National Farmers’ Helpline Centre Database who usually call the Farmers’ Help Line Centre of NAERLS, ABU Zaria. Percentage, and mean were used to analyse data. It was revealed that 61.2% who frequently accessed information from the National Farmers Helpline were male farmers belonging to the age group of 41 years and above (46.4%), married (75.6%) and having a household size of 6 – 10 persons (51.1%), with at least 11 – 30 years of farming experience. Thus, 45.6% of the respondents were involved in crop production while 37.5% were into animal husbandry, with the majority of them (46.9%) having acquired no form of formal education. Furthermore, the findings showed that the National Farmers Helpline Centre supplies the rural farmers with information on cultural practices (69.0%), pest and disease management (50.0%), weed management strategies (73.9%), marketing strategies (72.4%), farm tools and machineries (65.0%), seeds varieties and selection (88.9%) and information on government policies (89.0%). It was clearly identified that rural farmers are personally, infrastructural, resourcefully, mentally and managerially ready to access agricultural information from the National Farmers Helpline Centre. Rural and urban farmers should be committed in accessing the readily available agricultural information for a productive and sustainable agricultural productivity, likewise, reliable means of information dissemination should be adopted by the National Farmers Helpline Centre so as to ensure that both rural and rural farmers benefit from the numerous agricultural information available.</jats:p

Rural Farmers’ Readiness to Access Information from the National Farmers Helpline Centre, National Agriculture Extension and Research Liaison Services ABU Zaria, Kaduna State, Nigeria

The study investigated rural farmers’ readiness to access agricultural information from the National Farmers Helpline Centre NAERLS, ABU Zaria. The specific objectives were to describe the socio-economic characteristics of Nigerian rural farmers, identify the major agricultural information accessed by rural farmers from the National Farmers Helpline Centre and identify the various constraints faced by Nigerian rural farmers in accessing agricultural information from the National Farmers Helpline Centre. A random sampling technique was employed to select one thousand six hundred (1600) rural farmers across the six agro ecological zones from the National Farmers’ Helpline Centre Database who usually call the Farmers’ Help Line Centre of NAERLS, ABU Zaria. Percentage, and mean were used to analyse data. It was revealed that 61.2% who frequently accessed information from the National Farmers Helpline were male farmers belonging to the age group of 41 years and above (46.4%), married (75.6%) and having a household size of 6 – 10 persons (51.1%), with at least 11 – 30 years of farming experience. Thus, 45.6% of the respondents were involved in crop production while 37.5% were into animal husbandry, with the majority of them (46.9%) having acquired no form of formal education. Furthermore, the findings showed that the National Farmers Helpline Centre supplies the rural farmers with information on cultural practices (69.0%), pest and disease management (50.0%), weed management strategies (73.9%), marketing strategies (72.4%), farm tools and machineries (65.0%), seeds varieties and selection (88.9%) and information on government policies (89.0%). It was clearly identified that rural farmers are personally, Centre. Rural and urban farmers should be committed in accessing the readily available agricultural information for a productive and sustainable agricultural productivity, likewise, reliable means of information dissemination should be adopted by the National Farmers Helpline Centre so as to ensure that both rural and rural farmers benefit from the numerous agricultural information available. Infrastructural, resourcefully, mentally and managerially ready to access agricultural information from the National Farmers Helpline</jats:p

Relationship Of Serum Homocysteine And Vitamin B12 With Outcome Of Acute Ischemic Stroke In Nigeria

Background: Stroke has been a global burden, with increasing morbidity and mortality especially in developing countries. Studies had reported elevated levels of serum homocysteine(hcy) and vitamin B12 (Vit B12) in patients with stroke. Objectives: To determine the relationship between hcy, and Vit B12 outcome in acute ischaemic stroke Materials and Methods: Hundred acute Ischaemic stroke patients were recruited into the study and were followed up for 2years. Serum homocysteine and vitamin B12 was done using ELISA. Patients outcome either dead or alive was recorded at 1 month and at 24 months. Results: Majority of the participants 62% were males with hcy of 1.62±0.37µmol/L and 38% were females with hcy of 1.62±0.31µmol/L. Vit B12 of males were 97.00 (181.30,80.00) pg/ml and females had a Vit B12 of 90.00(140.00,70.00) pg/ml. Thirty-four percent of patients had hyperhomocysteinaemia (&gt;1.7µmol/L) while 64% had normal homocysteine levels. Also, 81% had hypovitaminosis B12 (&lt;199.72pg/ml) and 19% had normal vit B12 on admission. There was no statistically significant difference (p value =0.932) between mean hcy levels of 25 dead patients (1.67 ±0.22µmol/L) and 58 patients that survived at one month (1.68±0.37µmol/L). Similarly, there is no statistically significant difference (p value =0.869) between mean Vit B12 levels of 25 dead patients (113.75±79.37pg/ml) and 58 patients that survived at one month (117.50±87.17pg/ml). After 24months of follow up, 31patients died. There is no statistically significant difference (p value=0.328). between mean homocysteine of 31 dead patients (1.62±0.30µmol/L) and the 47 patients that survived (71±0.36µmol/L). There was no statistically significant difference (p value= 0.214) between the Vitamin B12 concentration of the dead patients (131.29±104.01pg/ml) compared to those who survived (106.81±68.73pg/ml). Conclusion: There is no relationship between Homocysteine and vitamin B12 with outcome in patients admitted with an acute ischaemic stroke</jats:p

The Role of National Farmers Helps Line in Agricultural Information Dissemination Among Crop Farmers in Nigeria: A Case Study of Farmers Help Line Centre, NAERLS ABU Zaria

The study examined the role of national farmers helpline in agricultural information dissemination among crop farmers in Nigeria, with the specific objectives to identify the various sources of information on agricultural practices available to the farmers and identify the various information disseminated to the farmers from the National Farmers Helpline. One Thousand farmers were randomly selected from the farmers who frequently call the Helpline Centre from the database of NAERLS across the six geo-political zones of Nigeria; to source the required information. Some of the crop farmers were contacted through phone calls, SMS, and social media platforms like Facebook and WhatsApp while some were through administration of questionnaires and face to face discussion. Data sourced were subjected to descriptive statistics such as frequency distribution and percentage for analysis and were presented in tables and charts. The findings reveal that the Farmers Help Line Centre, NEARLS supply farmers around the country with all the necessary information on cultural practices, access to improved seed varieties, fertilizer and application, pest and disease management practices, weed management practices, marketing strategies, post-harvest activities, management of farm tools and machineries and also information on Government policies on agriculture. It is recommended that stakeholders of National Farmers Help Line ensure the sustainability of its services by including other Nigerian languages to have a larger coverage and not limiting spoken languages to only the major Nigerian languages (English, Yoruba, Hausa, Igbo and Nigerian pidgin); and also extend their services to West African countries and other parts of the globe at large.&#x0D; Key words: Agriculture, information, dissemination and crop farmers </jats:p

Type 2 diabetes mellitus in an obese adolescent girl in Bauchi, northeast Nigeria

The prevalence of type 2 diabetes mellitus (T2DM) among children and adolescents is on the rise and this correlates well with increasing prevalence of obesity and overweight worldwide. T2DM was thought to be a disease of the adults, however this has since changed. High index of suspicion is required especially in obese children with family history of type T2DM. To the best of our literature search, till date, no case was reported from Northeast Nigeria. We hereby report a case of newly diagnosed type 2 DM in a 14-year old obese teenage girl, who presented with polyuria, polydipsia and weight loss. Her father is a T2DM patient. She had acanthosis and multiple ovarian cysts. She underwent acute phase of care with insulin before discharge and has remained euglycaemic and clinically state on oral hypoglycaemic agent.</jats:p